Curbside Consultation

Social Media Use and Mood Disorders: When Is It Time to Unplug?

Commentary by KAITLYN WATSON, MD, Wake Forest School of Medicine, Winston-Salem, North Carolina

DAVID C. SLAWSON, MD, University of Virginia School of Medicine, Charlottesville, Virginia

Am Fam Physician. 2017 Oct 15;96(8):537-539.

Case Scenario

A 25-year-old woman presented to my clinic with some mood issues that she was experiencing. From the moment I greeted her, she was entirely engrossed in her smartphone, rarely taking her eyes off of it. I could see it was the Facebook app that was demanding all of her attention. The patient described feelings of depression and anhedonia, as well as difficulty sleeping and concentrating. When I asked what was going on with her friends on Facebook, she broke down in tears, explaining that several of her friends had recently gotten married, one had a new baby, and some friends were even working abroad. Meanwhile, she had yet to find a fulfilling job, was not in any kind of serious relationship, and could not afford to travel. She was happy for her friends, but was also constantly reminded of the seemingly fabulous lives they were leading every time she looked at social media. She could not help but compare their lives and experiences with her own.

Is social media use something that physicians should discuss with patients, particularly those with mood disorders? If so, will the discussion make a difference?

Commentary

Americans spend more time on Facebook, the world's largest online social network, than any other website.1,2 On the surface, social media networks provide an “invaluable resource for fulfilling the basic human need for social connection.”1 However, rather than enhancing well-being by fulfilling communication needs that are deeply human, current research suggests that these online platforms may actually undermine it.1

Much of the current social media literature has focused on social media use and the fear of missing out, or FOMO, in the millennial age group (typically defined as persons born between 1980 and the early 2000s), although some research suggests that it is not limited solely to millennials.3

IDENTIFICATION

In 2013, the abbreviation FOMO was added to the Oxford dictionary and defined as “anxiety that an exciting or interesting event may currently be happening elsewhere, often aroused by posts seen on a social media website.”4 To avoid this feeling of being left out, some persons have an impulse to constantly connect with others through social media, which in turn can make them feel dissatisfied, anxious, and unworthy.2 Even when patients are not actually able to name anything in particular that they are missing out on, they may still possess fear that others are having a better time.3 This can lead not only to emotional symptoms, but also to physical symptoms, including shortness of breath, palpitations, headache, sore throat, chest pain, and less mindful attention.3,5

Social media use is feeding into a sense of relative deprivation, the “dissatisfaction people feel when they compare their positions to others and grasp that they have less,” particularly when they see their peers engaging in enviable experiences.3 One report found that American men are more likely to be affected by this phenomenon.3

HEALTH IMPACT

Recent studies of millennials demonstrate an association between increased social media use and increased rates of depression, anxiety, loneliness, and distracted driving, as well as lower levels of life satisfaction and productivity.1,6–9 Viewing social media intensifies feelings of irritability, anxiety, and inadequacy.2 Additionally, the drive to stay in the loop can contribute to a cycle of unhealthy social media use. The more time individuals spend on social media, the more likely they are to feel that they are missing out on something, which many will then try to alleviate through more social media activity.4,8 Higher FOMO scores, as measured by a validated 10-question scale, are significantly associated with lower feelings of competence, autonomy, and connectedness with others compared with persons who do not worry about being left out.8

In a study of undergraduate students, those who worried more about being left out were more likely to be checking Facebook during class lectures.8 More concerning, they were also more likely to be texting or e-mailing while driving.8 In fact, using Facebook more often, having more Facebook friends, and doing more impression management on Facebook may predict symptoms of other disorders besides depression and anxiety, including narcissistic, antisocial, obsessive-compulsive, and histrionic personality disorders, as well as bipolar disorder.9 Social media use and smartphone use, especially near bedtime, are also tied to lower-quality sleep.10

In a 2015 public opinion poll, approximately one-half of participants said they could not live without a smartphone.11 When separated from their phones in experimental studies, many participants exhibited symptoms classically associated with withdrawal from addictive substances, including anxiety, increased heart rate, and increased blood pressure.11 Slightly more than one-fourth of persons who responded to a 2013 online survey indicated they would be willing to give up reality te

Case scenarios are written to express typical situations that family physicians may encounter; authors remain anonymous. Send scenarios to afpjournal@aafp.org. Materials are edited to retain confidentiality.

This series is coordinated by Caroline Wellbery, MD, Associate Deputy Editor.